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Third universal definition of MI published

An updated definition of myocardial infarction (MI), which will be used to diagnose patients and define endpoints in clinical trials, was presented recently at the ESC Congress.

The document sets out the levels of troponin required for a diagnosis of procedural related myocardial infarction after percutaneous coronary intervention (PCI), coronary bypass (CABG), other cardiac procedures, and non-cardiac procedures.

“This is a controversial area because interventional cardiologists and surgeons do not want MI as a complication,” said Professor Kristian Thygesen (Aarhus University, Denmark), co-chair of the document Task Force. “It means that they want to set the levels of troponin as high as possible. It was also difficult to reach a consensus because it’s impossible to conduct a clinical trial to find the answer”.

During the development of the third universal definition the Task Force communicated with the US Food and Drug Administration (FDA) and it is anticipated that this definition could be used as the basis for clinical trial protocols designed according to FDA regulations. Professor Thygesen said: “This is significant because it will help to standardise the way MI is defined in clinical trials, making comparisons between trials more meaningful. Steering committees that write protocols for clinical trials do follow FDA requirements”.

This new document contains a brand new section describing these situations to help clinicians and scientists understand how they differ from MI. “This should help clinicians and scientists to make the correct diagnosis,” said Professor Thygesen.

The third universal definition will be published in five journals, almost simultaneously: European Heart Journal on behalf of the ESC, the Journal of the American College of Cardiology for the ACC and Circulation for the AHA. For the first time it will also be published in the World Heart Federation’s Global Heart and Nature Reviews Cardiology.

Professor Thygesen said: “This is a truly global document that will be used worldwide. It will help doctors diagnose their patients so that they can provide the most appropriate treatment, and help researchers design clinical trials with standardised endpoints”.